ENVELOP: Sårvård efter pilonidal sinuskirurgi (ENVELOP)
Excision och negativt tryck sårterapi kontra excision och lämna öppen med standard sårvård för hantering av kronisk pilonidal sinussjukdom - en randomiserad kontrollerad studie
This is a single-blinded, multicentre, prospective randomised controlled trial (RCT) comparing post-operative and patient-reported outcomes for patients undergoing application of negative-pressure wound therapy (NPWT) after sinus tract excision as compared to excision and standard open wound care in chronic pilonidal sinus disease (PSD).
Studieöversikt
Status
Betingelser
Intervention / Behandling
Detaljerad beskrivning
Pilonidal sinus disease (PSD) is a chronic inflammatory condition of the skin and subcutaneous tissues arising from hair follicles in the natal cleft. The definitive aetiology of the condition is unknown, however, it is theorised that it is the result of either the obstruction and subsequent inflammation of hair follicles or secondary to hair penetrating through the skin into the subcutaneous tissue. This results in infection, abscess formation, chronic discharge and pain. PSD is a common condition affecting 26 per 10,000 population, with the prevalence reaching 1.1% in young adult males.
PSD causes a significant burden on healthcare services due to high rates of recurrence and readmission following surgery, together with negative impacts on patients' quality of life and self-image. An effective management strategy for the disease is necessary to ensure that post-operative outcomes are optimised and patient-reported outcomes are satisfactory in those whose PSD requires surgery.
The objective of this multicentre, national RCT is to prospectively investigate the effect of negative pressure wound therapy compared to leaving open with standard wound care on time to wound healing following surgical excision of chronic PSD.
Studietyp
Inskrivning (Beräknad)
Fas
- Inte tillämpbar
Kontakter och platser
Studiekontakt
- Namn: Sean T Martin
- Telefonnummer: (01) 261 4037
- E-post: seanmartin@rcsi.ie
Studera Kontakt Backup
- Namn: Eanna Ryan
- Telefonnummer: (01) 261 4037
- E-post: eannaryan@rcsi.com
Studieorter
-
-
-
Castlebar, Irland
- Rekrytering
- Mayo University Hospital
-
Kontakt:
- Kevin Barry
-
Dublin, Irland
- Rekrytering
- Tallaght University Hospital
-
Kontakt:
- Dara Kavanagh
-
Dublin, Irland, D09V2N0
- Rekrytering
- Beaumont Hospital
-
Kontakt:
- John Burke
-
Dublin, Irland
- Rekrytering
- St James's Hospital
-
Kontakt:
- Michael Kelly
-
Dublin, Irland
- Rekrytering
- St Michael's Hospital, Dún Laoghaire
-
Kontakt:
- Helen Heneghan
-
Dublin, Irland
- Rekrytering
- St Vincent's Univeristy Hospital
-
Kontakt:
- Eanna Ryan
-
Kilkenny, Irland
- Rekrytering
- St. Luke's Hospital
-
Kontakt:
- Cathy Cronin
-
Limerick, Irland
- Rekrytering
- University Hospital Limerick
-
Kontakt:
- Colin Peirce
-
Tullamore, Irland
- Rekrytering
- Midlands University Hospital
-
Kontakt:
- Sean Johnston
-
Waterford, Irland
- Rekrytering
- University Hospital Waterford
-
Kontakt:
- Peter Neary
-
-
Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
Tar emot friska volontärer
Kön som är behöriga för studier
Beskrivning
Inclusion Criteria:
i) They are aged 18 years or older
ii) They are undergoing elective pilonidal sinus excision without primary closure
Exclusion Criteria:
i) They are unable to adhere to protocol requirements e.g. questionnaire completion
ii) They are undergoing emergency drainage for a pilonidal abscess
iii) They are undergoing surgery for pilonidal sinus disease in locations other than the natal cleft
iv) They have underlying osteomyelitis
v) They have underlying fistulating disease e.g. Crohn's
Studieplan
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Behandling
- Tilldelning: Randomiserad
- Interventionsmodell: Parallellt uppdrag
- Maskning: Enda
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
|---|---|
|
Experimentell: Negative Pressure Wound Therapy
The wound is dressed using negative pressure wound therapy. |
Following elective excision of chronic pilonidal sinus disease with the wound left open, NPWT is applied in theatre using a polyurethane foam-based system (e.g. VAC, Renasys-GO, Prevena or equivalent) cut to fit the wound cavity, sealed with an adhesive drape and connected to a portable pump at -125 mmHg continuous pressure. Dressings are changed every 48-72 hours in clinic until granulation reaches skin level, followed by standard dressings until epithelialisation. |
|
Aktiv komparator: Standard wound care (SWC)
Following excision, the wound is left open (no primary closure) and managed with standard dressings according to local protocol, with wound healing by secondary intention. |
Standard wound care |
Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
|
Time to complete wound healing
Tidsram: Up to 6 months post surgery
|
Number of days to complete epithelialisation or closure of the wound without any discharge, drainage, scab, and/or the requirement for further dressing. |
Up to 6 months post surgery
|
Sekundära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
|
Measure of post operative pain
Tidsram: Day of surgery, 28 days post surgery & 3 months post surgery
|
Pain measured by visual analogue pain scale (0 = no pain, 10 = worst pain) at rest, on walking and on sitting |
Day of surgery, 28 days post surgery & 3 months post surgery
|
|
Measure of post operative complications
Tidsram: 6 months post surgery
|
Post-operative complications, including surgical site infection (CDC criteria), seroma, abscess, readmission and return to theatre. |
6 months post surgery
|
|
To compare recurrence rates
Tidsram: 6 months post surgery
|
To compare the 6-month recurrence rates (recurrence being defined as the development of a new sinus or abscess within the natal cleft occurring after wound healing had been achieved) between the NPWT and SWC Groups |
6 months post surgery
|
|
Cost-effectiveness
Tidsram: 6 months post surgery
|
Within-trial cost-utility analysis from health-system and patient perspectives, expressed as incremental cost per QALY gained (QALYs from EQ-5D-5L, area under the curve). Resource use includes hospital and community contacts, dressing changes, complications, readmissions and returns to theatre, valued at Irish unit costs; patient costs and productivity losses via CoPaQ. |
6 months post surgery
|
|
Health-related quality of life with the EuroQol-5 dimensions five level index questionnaire (EQ-5D-5L)
Tidsram: Baseline, 1 month, 3 months & 6 months
|
The questionnaire covers five dimensions of health: mobility, self-care, usual activities, pain or discomfort, and anxiety or depression. Each dimension has 5 levels: no problems (1), slight problems (2), moderate problems (3), severe problems (4) and extreme problems (5). The patient is asked to indicate his/her health state by ticking the box next to the most appropriate statement in each of the five dimensions. Index values derived using the EQ-5D-5L value set specified in the Statistical Analysis Plan (Irish value set where available). |
Baseline, 1 month, 3 months & 6 months
|
|
Scar assessment - using the Patient and Observer Scar Assessment Scale (POSAS)
Tidsram: 28 days, 3 months, 6 months
|
The POSAS is made up of two scales: the patient and observer scales each comprise six items scored 1 to 10; each scale is summed (6 = normal, 60 = worst) and reported separately. |
28 days, 3 months, 6 months
|
|
Health-related out-of- Pocket Costs assessed using the Costs for Patients Questionnaire (CoPaQ)
Tidsram: 28 days, 3 months, 6 months
|
The CoPaQ measures patient and caregivers out-of-pocket expenses (direct and indirect) associated with a health condition |
28 days, 3 months, 6 months
|
Samarbetspartners och utredare
Utredare
- Huvudutredare: Sean T Martin, St. James's Hospital, Ireland
Studieavstämningsdatum
Studera stora datum
Studiestart (Faktisk)
Primärt slutförande (Beräknad)
Avslutad studie (Beräknad)
Studieregistreringsdatum
Först inskickad
Först inskickad som uppfyllde QC-kriterierna
Första postat (Faktisk)
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
Senast verifierad
Mer information
Termer relaterade till denna studie
Nyckelord
Ytterligare relevanta MeSH-villkor
Andra studie-ID-nummer
- RCSI-ENVELOP
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